Apollo Home Healthcare Limited's East Office received a Good overall rating following a focused inspection of the Safe and Well-Led key questions, with ratings unchanged from the previous inspection. Minor shortfalls were identified in medicines record-keeping and care plan detail, and a gap in overseas staff recruitment checks, all of which the registered manager promptly committed to address.
Concerns (4)
moderateRecord keeping — “staff had not always recorded the time they had administered medicines, or where the medicine had been applied on the person, such as a skin patch placed on top of the skin.”
moderateStaff training — “the provider had not always followed best practice guidance regarding the recruitment of staff from outside the UK in obtaining police reports from the country of origin.”
minor
Medication management
— “Staff did not always record the quantity of the dosage where the prescription offered this option.”
minorCare planning — “there were some missed opportunities to identify improvements, such as the detail in people's care plans and risks assessments.”
Strengths
· Staff were knowledgeable and skilled in applying safeguarding procedures and knew how to report concerns appropriately.
· Medicines were managed and administered safely by trained and competent staff, with people supported to make choices about their own medicines.
· Staff adhered to good infection prevention and control practices, including correct use of PPE and clinical waste disposal.
· The registered manager fostered an open, honest culture with effective learning when things went wrong and an overhauled accident and incident process.
· The provider worked in strong partnership with ICBs, GPs, social workers and other health professionals to deliver joined-up, person-centred care.
Apollo Home Healthcare's East Office was rated Good across all five key questions following a focused inspection triggered by concerns about safety, staffing levels, staff skills and missed visits, none of which were substantiated as putting people at risk. Minor issues were identified around medicines recording, dissatisfaction with cover arrangements during staff absence, and one unreported incident, but the registered manager had taken corrective action.
Concerns (8)
moderateStaffing levels — “a number of people were dissatisfied when alternative staff arrangements were implemented... They felt they could not always rely on the service”
moderateMissed or late visits — “There had been missed care visits and alternative arrangements including community nurses and people's relatives meant there was minimal change to people's care.”
minorMedication management — “where people required a number of tablets to make up a complete dose of the same medication, staff did not sign for each individual medicine. National guidance is that each dose must be signed for separately.”
minorStaff training — “Some people and relatives felt that some staff would benefit from additional training about always assuming people could consent to their care.”
minorGovernance — “Although not all incidents had been reported to us due to an internal communication issue... The registered manager now understood when we needed to be notified”
minorCommunication with families — “not all people had been consulted where changes had been made. The provider confirmed that people or their relatives would be contacted to make sure any alternative arrangements had been effective”
minorStaff competency — “where staff had not been able to provide people's care or where some people felt staff weren't competent.”
minorComplaints handling — “Whilst alternative staff arrangements were in place, such as in unexpected staff absences, these were not always as respectful or effective as expected.”
Strengths
· Robust safe recruitment processes including DBS, references and NMC registration checks
· Consistent staff team who knew people's needs and preferences well
· Detailed risk assessments and care plans updated promptly when needs changed
· Strong infection prevention and control practice with appropriate PPE use
· Person-centred care including supporting a person to go on holiday for the first time
Quality-Statement breakdown (23)
safe: Staffing and recruitmentNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Assessing risk, safety monitoring and managementNot rated
safe: Using medicines safelyNot rated
safe: Preventing and controlling infectionNot rated
safe: Learning lessons when things go wrongNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawNot rated
effective: Staff support: induction, training, skills and experience